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31.05.2014
Every year Footsteps Dance Studio creates a mini-ballet and presents it in the annual recital. There is a paucity of quality concussion education in entry level, residency, and post-professional medical education.
A bold statement as I introduce what I believe to be the worlds first yearlong, multidisciplinary, and post-professional concussion education program for clinicians. I was surrounded by people whom I genuinely cared about, professionally and personally, and I felt like my nose to the grindstone personality the last 13 years of formal didactic education, business mentorship, and the chase to this finish line had come to fruition. I was that patient rolling to CT with my MD Calculator in hand who was able to recite the Canadian CT Head Rules like a proud elementary school student who had just learned her speaking part for the school play. A one week medical leave of absence turned into 10+ hours of rehabilitation a week for a year. I strongly believe that these numbers continue to be greatly underestimated based off of the heterogenous nature of this injury, underreporting[1-4], ~25% of people not seeking emergency department or other medical care[5], and lack of an agreed upon definition and consensus on what the injury is in the literature[6-8]. We know that approximately 20-30% of patients develop persistent symptoms crossing over into the post concussion syndrome threshold each year with ranges from 5-58% in the literature[9-11]. If we look at ~30% of all concussions crossing over into the persistent symptom category, that is 1.14 million people in the United States based off of the current data alone. We know that TBI is grossly underfunded yet it is a major cause of death and disability in the United States, contributing to about 30% of all injury deaths[12].
According to the National Institutes of Health (NIH), Cancer research received $5.6 Billion in 2015. Scientifically, we must start with agreeing upon a universal definition of concussion, mTBI, and TBI. The above statistics indicate that we are doing much better at saving patients lives from severe cases of TBI vs cancer; however, the true burden exists with TBI survivors suffering from the lasting effects of what a TBI does to a person as a whole being. We know that 100% of all neuroprotection phase III studies are negative, less than 5% of New Medical Entities (NME) in clinical assessment make it to FDA approval, and 100% of all Phase III trials in TBI are negative. This means that there have been zero phase three clinical trials in TBI that have moved on to completion, there are zero drugs for TBI, and that TBI and concussion are strictly a clinical diagnosis. Historically in medicine if we do not understand an injury or disease pathway, we prescribe rest or send the patient to a psychologist e.g. It wasn’t until 1989, a neuropsychologist by the name of Jeffrey Barth, was part of the first group to suggest that cognitive testing in preseason athletes may have some value due to concussive injuries presenting lasting effects. We’ve enabled a culture of “I got my bell rung” to prevail and have not addressed concussion from a systems level until recently. I’ve heard time and time again that “We can’t teach it because there’s no empirical evidence”. As I was being well-cared for by my team of physicians and clinicians, I continued to do my best to take a step back and look at the inner workings of the healthcare team, system and educational offerings that are made available to all clinicians from physician to PT et al.
When I learned that 2015 was the first year that neurology residencies were receiving formal didactic education in concussion within the ‘Behavioral Neurology’ section springing from the work and advocacy of the Sports Neurology Section of the American Academy of Neurology, I knew there had to be something done. A change in the global architecture of medicine with respect to the concussion patient of today. I emphatically deliver this message when I speak publicly: it is not a matter of if you treat concussion patients. Long gone are the days of the one physician model, yet we seem to be in a conundrum when it comes to communication and teamwork in medicine. In the fall of 2014, I had the privilege to virtually attend the International College of Residency Education’s (ICRE) opening plenary delivered by rhetorician scientist Dr. She elaborates reviewing a case scenario describing the maze of disconnected care episodes that the patient of today is experiencing.
A concussed individual can experience any one of the following myriad of symptoms all at once or over a period of time [See Chart].
Each of these symptoms can be managed by individual specialists that may or may not cohesively integrate their treatment models with a co-treating clinician. Concussion identification, treatment, management, and having the self awareness to know when and whom to refer appropriately can be a complex team model and clinical algorithm.
We can’t simply “treat the headache” or “treat the balance issue.” Treating the concussion patient of today involves a complex series of evaluations across all domains in order to systematically identify injury deficits in order to appropriately make the decision of what to treat, when to treat it, and when to refer appropriately.
Concussion is an injury of asynchronous firings at a cellular level which accumulate amounting to a functional dysfunction with ones self and environment. We need to learn how to adapt to the needs of our patients who carry a host of pre and post morbid medical conditions and circumstances presenting with the complexities that the heterogenous nature of a concussive injury presents. The Evidence In Motion Concussion Certificate Program is committed to educating the post-professional multidisciplinary clinician of today in concussion identification, treatment, and management by fostering a rehabilitative team approach.
This 12-month program provides the latest clinical conversations, evidence-based guidelines, and consensus statements while integrating real world experiences from patients, providers, and caregivers who have navigated the complex healthcare network of today.
Content delivery is both interactive and dynamic, exposing the student to some of the most influential clinicians in the concussion community coupled with the unique learning experience of provider to provider, patient to provider, and caregiver to provider storytelling.
By fostering a rehabilitative team approach, the EIM Concussion Certification hopes to facilitate collective competence across the healthcare continuum in order to better triage, treat, and appropriately refer the concussion patient of any age from acute to chronic stages. This year long multidisciplinary concussion certificate sets the learner up for success utilizing an asynchronous and synchronous online learning environment for the busy post professional of today. The in-person weekend intensive reviews the psychomotor properties of the concussion evaluation, treatment, management, and referral options based off of the providers scope of practice during the 12 month didactic education experience. As a pre-requisite to the program, each post-professional student will undergo a therapeutic neuroscience education course.
Current best-evidence shows that therapeutic neuroscience education improves pain ratings, function, pain catastrophization, physical movement and cost of healthcare utilization. A few months before physician Kenneth Schwartz died, he stated that “Quiet acts of humanity have felt more healing than the high dose of radiation and chemotherapy that hold the hope of a cure. I hope to create kind, compassionate, and clinically efficient clinicians who foster rapport with patients, interdisciplinary colleagues, and across disciplines.
I’ve been fortunate enough to have returned back to patient care and have surrounded myself with some of the brightest and most dedicated faculty in the world in their respected specialties. Over the last year, the energy that I’ve felt from this group of men and women has been palpable. We have a tall order in front of us and I know we’re here to do our best to help clinicians of today put our best foot forward to educate each other and our communities of coaches, parents, spouses, teachers, caregivers, and loved ones on the multifaceted injury that concussion can present itself as to the provider and patient of today.
Storytelling allows us to step back, view, and listen from an aerial and reflective standpoint while creating the neural groundwork of patient exposure by connecting to the story, the provider, the caregiver, and the patient.
Schwartz Rounds were invented by an ill physician who also experienced the dichotomy of both doctor and patient.
How can we help and treat a mutual patient if we don’t sincerely understand what each of us can collectively do for one another in the best interest of the patient. Story allows us to experience the injury through the eyes of experienced providers, patients, and caregivers who have navigated the complex healthcare system of today. This is a notion that America has been taught to believe, allowing consumers the freedom to trust that any food from the supermarket or restaurant has a place in our diet- as long as we manage to balance calories in with calories out. Americans doubled their intake of sugar by 2000 and 80% of products available in the supermarket now contain added sugar [4].
Comprehending how added sugars are processed for energy helps explain why calories from different foods have varying impacts on fat storage and appetite.
When you eat an apple, the fiber allows the sugar to gradually absorb into the bloodstream.
Furthermore, insulin spikes lead to blood sugar crashes, advancing the signal to the brain that you need to more food. In short- the calories in the apple lead to satiety and energy while the calories from the apple juice lead to hunger and lethargy- all due to the way sugar is metabolized.
The American Heart Association recommends just 6 grams of added sugar per day for women and 9 grams for men [8]. For an effective visual, fill empty bottles of soda, juice and a sports drink with the number of teaspoons of sugar they contain (1 gram= 4 teaspoons). Just as our palates have been conditioned to crave sugar, they can be conditioned to crave it less [4]. Coffee drinkers can train their palate by gradually decreasing the number of sugars while soda drinkers can start by diluting them with water. On May 16, 2015, I had the privilege to speak in front of 200 of my colleagues at Evidence in Motion’s 3 day hands-on and didactic learning festival, Manipalooza, at the University of Colorado’s Anshutz Medical Campus in Denver, Colorado. Topics of discussion and practical application included concussion, neuroscience, biases in healthcare, manipulation, pelvic health, workplace safety, advanced soft-tissue mobilization, and an epidemiological review of low back pain: where it’s been, where we are going, and how the physical therapist is leading the way.
I was inspired by the impressive cohort of speakers (Timothy Flynn, John Childs, Larry Benz, Adrian Louw, Jennifer Stone, John Groves, Julie Whitman, Teresa Shuemann, Tim Fearon, and humbly- myself) and that of the volunteer Fellows, past and present, to assist with knowledge dissemination and translation throughout the entire weekend. I have learned that when you are surrounded by some of the top minds in the world who collectively come together with two interests in mind: 1.
This low-ego, incredibly fun, and contagiously charismatic group of doctors, clinicians, and scientists was truly an impressive group to be a part of in all domains to engage with, learn from, and disseminate knowledge to a hungry audience of motivated professionals. May 16, 2015 was particularly profound for me because I essentially got to go public with my story for the first time…and who better to present to than “my own people”, Physical Therapists.
The Schwartz adaptation of the David Sackett’s, MD Evidence Based Medicine (EBM) triangle including patient experience. I said it time and time again during my physical, orthopedic, neurologic, and cognitive rehabilitation throughout the year… “if I don’t share this story with the medical community it’s essentially malpractice in my eyes”.
I have one goal: facilitate collective competence amongst the healthcare community in order to better identify, treat, and manage the concussion patient along the entire continuum of recovery from acute to chronic. I was able to update the audience on some of the latest happenings in concussion research and development, review some stigmas associated with post-concussive syndrome, present my case revealing the patient was myself about half way through the presentation, share some poignant moments of what it was like to live through post-concussive syndrome, and announce the Evidence in Motion Concussion Certificate Program for the post-professional medical provider.
I am absolutely thrilled to be leading this program with the key concept of instilling collective competence across the healthcare continuum so we as clinicians can 1. A key theme of my professional being and future lecture series as it pertains to the concussion patient is built around the concept that there is no one provider who can comprehensively treat this population of patient.
Faculty will include some of the top minds, researchers, and clinicians in the world collectively coming together to educate the post-professional academic learner. Collectively, these incredibly bright and motivated minds will come together and I, as program director, will bridge the gaps empowering the clinician along the course of one year to become comfortable with their clinical abilities, their interdisciplinary colleagues, and most importantly- this cohort of concussion patient who is so often mismanaged in this maze of disconnected care episodes that healthcare system of today has unfortunately bred. Future information will be launched soon on the Evidence in Motion’s website for a Summer 2015 launch date. I look forward to being a part of an incredible movement to educate the healthcare practitioner in an online and in-person synchronous and asynchronous learning environment. Cheers to a tremendous year to come for both the patient and provider with respect to the identification, treatment, and management of the concussion patient! Thank you for time, attention, and coming along this exciting journey of advocacy as post-concussive survivor, story-teller, and educator.
Other than congenital anomalies, drowning is the number one cause of accidental death in children 1-4 years old. As clinicians who work directly with pediatric patients or treat an adult patient population, we all have contact with parents of young children professionally and familially.
As spring months turn into hot summer days and nights, what is the solution to assist our communities in keeping our children safe from the number one cause of pediatric accidental death? Infant Swimming Resource (ISR) is a program that teaches infants as young as 6 months how to save themselves in the event they make it into the water alone. ISR is recognized internationally as the safest provider of survival swimming lessons for children 6 months to 6 years. With nearly 50 years of research and development, Dr Harvey Barnett adapted his theoretical knowledge as a behavioral scientist in order to pioneer ISR’s Self-Rescue® method after witnessing the drowning of his neighbors infant son.
Children 1-6 years old learn to swim until they need air, roll back to float, and then resume swimming until they reach the side of the pool.
As of April 2015, there have been more than 800 documented cases where former ISR students have used their Self-Rescue® skills to independently save their own lives.
ISR Instructors are infant aquatic specialists who have been trained to teach water survival skills to infants and children 6 months to 6 years.
There is a minimum of 60 hours in-water training and 40 hours academic preparation and testing. Similar to many medical models, continuing education is required coupled with yearly re-certification to ensure maintenance of teaching skills.
Many ISR instructors come from medical backgrounds (physical therapy, occupational therapy, nursing, et al) and use evidence based knowledge regarding sensorimotor learning to teach these Self-Rescue® skills. The ISR instructor monitors the child’s temperature through vasoconstriction checks throughout the lesson, and if the child is too cold, the lesson is over. ISR instructors rely on sensorimotor principles and positive reinforcement to teach each infant and child during their personalized lesson. Based off of these sole principles alone, this is why the allied healthcare professional is the perfect fit to undergo this highly specialized training.
ISR teaches infants as young as 6 months old; therefore, verbal instruction cannot be relied on to teach survival swimming skills which primarily involve instinct, cognitive and motor planning tasks. The 10 minute lesson structure has been scientifically proven to optimize learning and increase retention for this pediatric age population.
Prolonged exposure to environments that are lower than a child’s body temperature are inefficient for motor learning. ISR lessons ensure that a child is competent and confident swimming and floating fully clothed. Family medical history, developmental milestones , current health conditions, developmental issues and medications.
Child’s name and age is recorded and a parent signs a waiver to acknowledge risk of lessons. Daily bowel, urine, diet and sleep patterns are documented in order to assess changes that may compromise the safety of lessons. For every pediatric fatal drowning, there are an additional 5 pediatric patients who visit the emergency department (ED) for nonfatal submersion injuries.


More than 50% of drowning victims treated in ED’s require long term hospitalization or transfer for further care. As an ISR instructor, it’s imperative to educate the community that water isn’t recreational until a child can survival float and swim. If you are interested in holding a pediatric Grand Round for more in depth information, Harvey Barnett PhD provides in depth information to the healthcare community on the behavioral approach to pediatric drowning prevention. I challenge you to educate five other healthcare professionals, friends, or family after reading this article.
Kristine McCarren is a Doctor of Physical Therapy (DPT) and Certified Infant Swimming Resource (ISR) Instructor residing in Mt. Globalization+ Globalization (or globalisation) is the process of international integration arising from the interchange of world views, products, ideas and other aspects of culture. Though scholars place the origins of globalization in modern times+, others trace its history long before the European Age of Discovery+ and voyages to the New World+. The term ''globalization'' is derived from the word ''globalize'', which refers to the emergence of an international network of economic systems. Economist Takis Fotopoulos+ defined "economic globalization" as the opening and deregulation of commodity, capital and labor markets that led toward present neoliberal+ globalization. Manfred Steger+, professor of Global Studies+ and research leader in the Global Cities Institute+ at RMIT University+, identifies four main empirical dimensions of globalization+: economic, political, cultural, and ecological, with a fifth dimension - the ideological - cutting across the other four. Lechner and Boli (2012) define it as more people across large distances becoming connected in more and different ways.
There are both distal and proximate causes+ which can be traced in the historical factors affecting globalization. Archaic globalization+ is seen as a phase in the history of globalization+ conventionally referring to globalizing events and developments from the time of the earliest civilizations until roughly the 1600s. Also posited is a 'multi-polar' nature to archaic globalization, which involved the active participation of non-Europeans.
Trade on the Silk Road+ was a significant factor in the development of the civilizations of China, the Indian subcontinent+, Persia+, Europe, and Arabia+, opening long-distance, political and economic interactions between the civilizations. Early modern globalization is distinguished from modern globalization on the basis of expansionism, the method of managing global trade, and the level of information exchange. During the 19th century, globalization approached its modern form as a direct result of the industrial revolution+. After the Second World War, work by politicians led to the Bretton Woods conference+, an agreement by major governments to lay down the framework for international monetary policy, commerce and finance, and the founding of several international institutions intended to facilitate economic growth multiple rounds of trade opening simplified and lowered trade barriers. Since the 1970s, aviation has become increasingly affordable to middle classes in developed countries.
In the late 19th and early 20th century, the connectedness of the world's economies and cultures grew very quickly. The migration+ and movement of people can also be highlighted as a prominent feature of the globalization process. Globalized society offers a complex web of forces and factors that bring people, cultures, markets, beliefs and practices into increasingly greater proximity to one another. With improvements in transportation+ and communication, international business grew rapidly after the beginning of the 20th century.
International business arrangements have led to the formation of multinational enterprises (MNE), companies that have a worldwide approach to markets and production or one with operations in more than one country.
Businesses generally argue that survival in the new global marketplace requires companies to source goods+, services+, labor+ and materials overseas to continuously upgrade their products and technology in order to survive increased competition. International trade+ is the exchange of capital+, goods+, and services+ across international borders+ or territories.
An absolute trade advantage+ exists when countries can produce a commodity with less costs per unit produced than could its trading partner. Establishment of free trade areas has become an essential feature of modern governments to handle preferential trading arrangements with foreign and multinational entities. A special economic zone+ (SEZ) is a region in which laws such as taxes and customs regulations are more financially libertarian than a country's typical laws. A FTZ is an area within which goods may be landed, handled, manufactured or reconfigured, and reexported without intervention by the customs authorities.
A free trade area+ is a trade bloc+ whose member countries have signed a free-trade agreement, which eliminates tariff+s, import quota+s, and preferences on most (if not all) goods+ and services traded between them. Qualifying Industrial Zones+ (QIZ) are industrial parks in Jordan+ and Egypt that allow these countries to take advantage of the free trade agreements between the United States and Israel. The Asia-Pacific+ has been described as "the most integrated trading region on the planet" because its intra-regional trade accounts probably for as much as 50-60% of the region's total imports and exports.
It has also extra-regional trade: consumer goods exports such as televisions, radio+s, bicycles, and textiles into the United States, Europe, and Japan fueled the economic expansion. Tax havens have been criticized because they often result in the accumulation of idle cash that is expensive and inefficient for companies to repatriate+.
Economic globalization is the increasing economic interdependence of national economies across the world through a rapid increase in cross-border+ movement of goods, service, technology and capital.Joshi, Rakesh Mohan, (2009) International Business, Oxford University Press, New Delhi and New York ISBN 0-19-568909-7.
In 1944, 44 nations attended the Bretton Woods Conference+ with a purpose of stabilizing world currencies and establishing credit for international trade in the post World War II era.
In India, business process outsourcing+ has been described as the "primary engine of the country's development over the next few decades, contributing broadly to GDP growth, employment growth, and poverty alleviation". The global economy, or world economy, is the economy+ of the world, considered as an international exchange of goods and services. By the early 21st century, a worldwide framework of legal agreements, institutions, and both formal and informal economic actors+ came together to facilitate international flows of financial capital+ for purposes of investment+ and trade financing+. While within-country income inequality has increased throughout the globalization period, globally inequality has lessened as developing countries have experienced much more rapid growth.
Economic inequality affects equity+, equality of outcome+ and subsequent equality of opportunity+. We have highley experienced faculty for teaching electronic music production and sound engineering course, who have Worked on the Above bollywood projects as Sound Engineer, Dubbing Engineer or Mixing Engineer.
Kavita Krishanurty, Sukhvinder Singh, Arijit Singh, Shreya Ghoshal, Kunal Ganjawala, Shaan, Toshi Rana Etc. I was mastering the craft of treating the patient as person, developing my patient rapport tools, building a wonderful international referral network, and understanding the nuances of running multiple successful businesses.
Comparatively and up from $88 million in 2015, TBI is estimated to receive just $91 million in 2016[13]. From there we need to be able to break down the injury appropriately based off of neurophysiological changes and injury to specific areas of the brain. This is an added anguish by medical personnel delivering insensitive messages that can often engender more emotional suffering than the actual illness itself[15]. Over the last few decades, we’ve allowed the medico-legal literature to get ahead of us in the medical community. It can often require a team of clinicians to identify, treat, and manage this patient population.
It can range from the athletic trainer, the emergency department physician, the primary care physician, the pediatrician, the nurse practitioner, the physician assistant, the school nurse, psychologist, physical therapist, occupational therapist, speech therapist, and anyone who has direct access to the patient of today.
Lorelei Lingard on Collective Competence: Adapting our concept of competence to healthcare teams[16]. Lingard’s words helped facilitate my eureka moment of how I can aide in providing a solution to this medical world of specialists all attempting to treat the same poorly defined and heterogenous injury.
Lingard states that we need to “evaluate in situ, broaden focus beyond individual actions to include inter-actions among individuals, capture the ‘cracks’ between the care episodes, and consider interactions among elements of the system, not just among people…Competence is a way of ‘seeing’ that both directs and deflects our attention. Patient stories of seeking care from 5+ medical providers until they “find their person” in healthcare is not uncommon. Basic science has identified symbiosis throughout the natural world ranging from the firing of an action potential to the marvelous making of what happens between winter and spring.
As we embark on a multidisciplinary educational journey together, I sincerely believe that we all speak the same language of medicine; however, we bring many different dialects to the clinical table. I am honored everyday to have worked with and continue to collaborate with each and everyone of these passionate clinicians. I systematically screened all interviewees for passion, high IQ, high EQ, and low ego who have the self awareness to take a step back from themselves and look at the big picture of clinical care. His purpose was to facilitate understanding of how the patient perceives their own illness and treatment by deploying empathy and building rapport[15]. I believe by deeply listening to each other, patients, and caregivers fosters an excellent way to change the way in which we begin to shift the global architecture of medicine with respect to the concussion patient of today. These processes combine to induce lethargy and hunger that contributes to more eating, less physical activity, more fat formation, and overall weight gain [4].
The average American consumes 80 grams of sugar per day [9] while a 12 ounce can of regular soda contains 32 grams of sugar [10]. Patients will be surprised at how much sugar they are drinking when they see it presented in this way. In fact, more than 8,000 scientific papers have been published on the health effects of added sugars [11].
I continue to hold strong to these goals and values of transparency, story-telling, and sharing of my own personal journey with the goal of increasing concussion patient-provider connectedness in the medical community. McCarren educate the medical community about the benefits of infant and child rescue swimming via her guest blog post on PT2Go. Lessons focus on teaching the child to roll onto their back to float, rest, and breathe maintaining this life-saving position until help arrives. After this initial level of mastery, winter clothes including a coat, boots, hat, and gloves are added into the lesson.
When a child is submerged underwater for 4-6 minutes, they can be left with irreversible brain damage. Not only will you be educating the medical community, you could directly be a part of saving a child’s life. McCarren is experienced in the pediatric setting and dually practices physical therapy in the outpatient orthopedic and homecare settings.
Globalization and women in China+ The study of the impact of globalization on women in China examines the role and status of Chinese women relative to the political and cultural changes that have taken place in the 20th century as a consequence of globalization.
One of the earliest known usages of the term as a noun was in a 1930 publication entitled, ''Towards New Education'', where it denoted a holistic view of human experience in education. Friedman+ popularized the term "flat world"+, arguing that globalized trade+, outsourcing+, supply-chaining+, and political forces had permanently changed the world, for better and worse. He used "political globalization" to refer to the emergence of a transnational elite and a phasing out of the nation-state+. This term is used to describe the relationships between communities and states and how they were created by the geographical spread of ideas and social norms at both local and regional levels. The first is the idea of Eastern Origins, which shows how Western states have adapted and implemented learned principals from the East. Because it predated the Great Divergence+ of the nineteenth century, in which Western Europe+ pulled ahead of the rest of the world in terms of industrial production and economic output, archaic globalization was a phenomenon that was driven not only by Europe but also by other economically developed Old World+ centers such as Gujarat+, Bengal+, coastal China and Japan. Early on, the geographic position of Greece and the necessity of import+ing wheat forced the Greeks to engage in maritime trade. Though silk was certainly the major trade item from China, many other goods were traded, and religions, syncretic+ philosophies, and various technologies, as well as diseases, also travelled along the Silk Routes. The period is marked by such trade arrangements as the East India Company+, the shift of hegemony+ to Western Europe, the rise of larger-scale conflicts between powerful nations such as the Thirty Year War, and a rise of new commodities – most particularly slave trade+. Industrialization allowed standardized+ production of household items using economies of scale while rapid population growth created sustained demand for commodities. Initially, the General Agreement on Tariffs and Trade+ (GATT), led to a series of agreements to remove trade restrictions.
Open skies+ policies and low-cost carrier+s have helped to bring competition to the market. This slowed down from the 1910s onward due to the World Wars and the Cold War+ but picked up again in the 1980s and 1990s. In the period between 1965–90, the proportion of the labor force migrating approximately doubled. One influential event was the late 2000s recession+, which was associated with lower growth (such as cross-border phone calls+ and Skype+ usage) or even temporarily negative growth (such as trade) of global interconnectedness. A MNE may also be called a multinational corporation+ (MNC) or transnational company (TNC).
In most countries, such trade represents a significant share of gross domestic product+ (GDP). By the same reasoning, it should import commodities in which it has an absolute disadvantage. Types of SEZs include free trade zones+ (FTZ), free zones+ (FZ), industrial park+s, and free port+s.
Only if the goods are moved into the rest of the country do they become subject to customs duties+.
If people are also free to move between the countries, in addition to a free-trade area, it would also be considered an open border+. The ASEAN Free Trade Area+ is a trade bloc+ agreement by the Association of Southeast Asian Nations+ supporting local manufacturing in all ASEAN countries. Whereas the globalization of business is centered around the diminution of international trade regulations as well as tariffs, taxes, and other impediments that suppresses global trade, economic globalization is the process of increasing economic integration+ between countries, leading to the emergence of a global marketplace or a single world market. While the international economic order envisioned by the conference gave way to the neo-liberal economic order prevalent today, the conference established many of the organizations essential to advancement towards a close-knit global economy+ and global financial system+, such as the World Bank+, the International Monetary Fund+, and the International Trade Organization+. Scholars find that China has attained a degree of openness that is unprecedented among large and populous nations, with competition from foreign goods in almost every sector of the economy. In some contexts, the two terms are distinguished: the "international" or "global economy" being measured separately and distinguished from national+ economies while the "world economy" is simply an aggregate of the separate countries' measurements.


This global financial system emerged during the first modern wave of economic globalization+, marked by the establishment of central bank+s, multilateral+ treaties+, and intergovernmental organization+s aimed at improving the transparency+, regulation+, and effectiveness of international markets. Economic inequality varies between societies, historical periods, economic structures or systems (for example, capitalism+ or socialism+), ongoing or past wars, between genders+, and between differences in individuals' abilities to create wealth+. Although earlier studies considered economic inequality as necessary and beneficial, some economists see it as an important social problem. Income differences between rich and poor countries are very large, although they are changing rapidly. Each year a different type of ballet is selected either being a classically known ballet; an abstract ballet, a romantic, comedic or tragic ballet, or a Footsteps Ballet Department original. Approximately 5.6 million people are living with the long terms effects of TBI and 138 deaths occur per day[12] amounting to ~50,000 deaths per year in the US. While these are lofty goals, I also don’t see this being tangible in the near future nor is it clinically and functionally relevant to the patient seeking care in front of us today. The cracks between care episodes, experts cultivating collective competence ‘know how the system usually fails in this situation, and plans accordingly.’ Our attention is directed towards individual competence and deflected from collective competence. Robert Rosenthal published a landmark article revealing the central tenets of “relationship magic,” the recipe for rapport. As a result of the recommendation to decrease fat consumption, food companies dialed down the fat in their products while substituting sugar to maintain palatability [3]. Offering perspective as to how much added sugar we consume can help patients gain awareness and motivate them to make a change.
Purchasing whole grain products keep the fiber intact so that the sugar is absorbed more gradually. By investing a few minutes to discuss their importance, you play a key role in drastically improving patients’ overall health and well-being.
I had the good fortune to be cared for by the incredible team of physicians, non-physician doctors, and clinicians at the New York University Concussion Center for 10+ hours a week for about a year of rehabilitation and guidance so I could successfully Return to Life with my new abilities. How can we refer to one another if we sincerely don’t have a grasp of what each of us across the healthcare continuum can do for one another as provider and for our mutual patient?
Here, she will touch upon pediatric emergency department drowning epidemiology, the American Academy of Pediatrics stance on swim lessons, and differentiate between the Infant Swimming Resource and traditional swim lesson model.
Children are monitored for temperature fatigue frequently throughout each lesson via vasoconstriction checks. Swimming and floating in clothes is a completely different experience than in a bathing suit. Ensuring that infants and toddlers can survival float and swim before they walk is critical to prevent drowning. She is most passionate about preventing childhood drowning through parent education and instruction of ISR techniques. Globalization and disease+ Globalization, the flow of information, goods, capital and people across political and geographic boundaries, has helped spread some of the deadliest infectious diseases known to humans.
ISBN 978-0803983243 Advances in transportation+, such as the steam locomotive+, steamship+, jet engine+, container ships+, and in telecommunication+s infrastructure, including the rise of the telegraph+ and its modern offspring, the Internet+, and mobile phones+, have been major factors in globalization, generating further interdependence+ of economic and cultural activities. A related term, ''corporate giants'', was coined by Charles Taze Russell+ in 1897 to refer to the largely national trusts and other large enterprises of the time. He asserted that the pace of globalization was quickening and that its impact on business organization and practice would continue to grow.
James has also argued that four different forms of globalization can be distinguished that complement and cut across the solely empirical dimensions+.
Without the traditional ideas from the East, Western globalization would not have emerged the way it did. In addition to economic trade, the Silk Road served as a means of carrying out cultural trade among the civilizations along its network.
The Triangular Trade+ made it possible for Europe to take advantage of resources within the western hemisphere. In the 19th century, steamships+ reduced the cost of international transport significantly and railroads+ made inland transport cheaper. GATT's successor was the World Trade Organization+ (WTO), which provided a framework for negotiating and formalizing trade agreements and a dispute resolution process.
In the 1990s, the growth of low-cost communication networks cut the cost of communicating between different countries.
The revolutions of 1989+ and subsequent liberalisation in many parts of the world resulted in a significant expansion of global interconnectedness. The DHL Global Connectedness Index studies four main types of cross-border flow: trade (in both goods and services), information, people (including tourists, students and migrants) and capital.
Well known MNCs include fast food+ companies such as McDonald's+ and Yum Brands+, vehicle manufacturers such as General Motors+, Ford Motor Company+ and Toyota+, consumer electronics companies like Samsung+, LG+ and Sony+, and energy companies such as ExxonMobil+, Shell+ and BP+.
Industrialization+, advanced transport+ation, multinational corporation+s, offshoring+ and outsourcing+ all have a major impact on world trade.
While there are possible gains from trade+ with absolute advantage, comparative advantage+ – that is, the ability to offer goods and services at a lower marginal+ and opportunity cost+ – extends the range of possible mutually beneficial exchanges. Free trade zones are organized around areas with geographical advantages for trade, such as major seaports, international airports, and national frontiers.
The international trade of endangered species+ was second only to drug trafficking among smuggling "industries". Depending on the paradigm, economic globalization can be viewed as either a positive or a negative phenomenon. Foreign investment helped to greatly increase product quality and knowledge and standards, especially in heavy industry.
It is common to limit questions of the world economy exclusively to human economic activity+, and the world economy is typically judged in monetary terms, even if there is no efficient market to help valuate certain goods or services, or if establishing figures is difficult. The world economy+ became increasingly financially integrated+ throughout the 20th century as nations liberalized capital accounts and deregulated financial sectors. Early studies suggesting that greater equality inhibits economic growth+ did not account for lags between inequality changes and growth changes. Per capita incomes in China and India doubled in the prior twenty years, a feat that required 150 years in the US. Dancers participating and performing have included students of all levels and ages ranging from 7 to adult. In 2015, there were 1,658,370 new cancer cases diagnosed and 589,430 cancer deaths in the US[14].
This only exists when three elements are present: mutual attention, shared positive feeling, and a well-coordinated nonverbal duet. Murphy, Towards an operational definition of sports concussion: identifying a limitation in the 2012 Zurich consensus statement and suggesting solutions. The extra weight of the clothes and fully saturated diaper make moving in the water more difficult. She underwent her Infant Swim Resource certification in Casselberry, Florida where she became a Certified ISR Instructor. In the late 19th century and early 20th century, the connectivity of the world's economies+ and cultures+ grew very quickly. By the 1960s, both terms began to be used as synonyms by economists and other social scientists. Other of his usages included "ideological+ globalization", "technological+ globalization" and "social globalization". According to James, the oldest dominant form of globalization is embodied globalization, the movement of people. The movement of people, such as refugees, artists, craftsmen, missionaries, robbers and envoys, resulted in the exchange of religions, art, languages and new technologies. The transfer of animal stocks, plant crops and epidemic diseases associated with Alfred Crosby+'s concept of The Columbian Exchange+ also played a central role in this process.
It shows that the depth of global integration fell by about one-tenth after 2008, but by 2013 had recovered well above its pre-crash peak.
In a globalized business environment, companies argue that the comparative advantages offered by international trade have become essential to remaining competitive. It is a region where a group of countries has agreed to reduce or eliminate trade barriers. Different jurisdiction+s tend to be havens for different types of taxes and for different categories of people and companies. While investigations of illegal tax haven abuse have been ongoing, especially in light of the 2015 HSBC files revelations, there have been few convictions.
Traditional Chinese medicine+ often incorporates ingredients from all parts of plants, the leaf, stem, flower, root, and also ingredients from animals and minerals. Economic globalization comprises the globalization of production+, markets+, competition+, technology, and corporations and industries. China's experience supports the assertion that globalization greatly increases wealth for poor countries.
With greater exposure to volatile capital flows, a series of financial crises+ in Europe, Asia, and Latin America had contagious effects on other countries.
Later studies claimed that one of the most robust determinants of sustained economic growth is the level of income inequality. According to the United Nations+ Human Development Report for 2013, for countries at varying levels of the UN Human Development Index+ the GNP+ per capita grew between 2004 and 2013 from 24,806 to 33,391 or 35% (very high human development), 4,269 to 5,428 or 27% (medium) and 1,184 to 1,633 or 38% (low) PPP$, respectively (PPP$ = purchasing power parity+ measured in United States dollar+s). Globalizing processes affect and are affected by business+ and work+ organization, economics+, socio+-cultural+ resources, and the natural environment+. Economist Theodore Levitt+ is widely credited with coining the term in an article entitled "Globalization of Markets", which appeared in the May–June 1983 issue of Harvard Business Review+. The interactions amongst states were not on a global scale and most often were confined to Asia, North Africa, the Middle East and certain parts of Europe. The term describes the phase of increasing trade links and cultural exchange that characterized the period immediately preceding the advent of high 'modern globalization' in the late 19th century. Early modern trade and communications involved a vast group including European, Muslim+, Indian, Southeast Asian and Chinese merchants, particularly in the Indian Ocean region. The approach of using global agreements to advance trade stumbled with the failure of the Doha round+ of trade negotiation.
The central feature of a tax haven is that its laws and other measures can be used to evade or avoid the tax laws or regulations of other jurisdictions. The use of parts of endangered species (such as seahorses+, rhinoceros+ horns, saiga antelope+ horns, and tiger+ bones and claws) resulted in a black market+ of poachers who hunt restricted animals. Current globalization trends can be largely accounted for by developed economies+ integrating with less developed economies+ by means of foreign direct investment+, the reduction of trade barrier+s as well as other economic reform+s and, in many cases, immigration+. By the early 21st century, financial institutions had become increasingly large with a more sophisticated and interconnected range of investment activities. That newly formed fat is released into the bloodstream, blocking the effect of the satiety hormone, leptin [7].
However, the term 'globalization' was in use well before (at least as early as 1944) and had been used by other scholars as early as 1981. With early globalization it was difficult for states to interact with others that were not within close proximity. This phase of globalization was characterized by the rise of maritime European empires, in the 16th and 17th centuries, first the Portuguese+ and Spanish Empire+s, and later the Dutch+ and British Empire+s. Globalization in this period was decisively shaped by nineteenth-century imperialism+ such as in Africa+ and Asia+.
Many countries then shifted to bilateral or smaller multilateral agreements, such as the 2011 South Korea–United States Free Trade Agreement+. These business transactions involve economic resources such as capital+, natural+ and human resources+ used for international production of physical goods and services such as finance+, banking+, insurance+, construction+ and other productive+ activities. Thus, when the United States experienced a financial crisis early in that century, it quickly propagated among other nations. Levitt can be credited with popularizing the term and bringing it into the mainstream business audience in the later half of the 1980s. Eventually, technological advances allowed states to learn of others existence and another phase of globalization was able to occur.
In the 17th century, world trade developed further when chartered companies+ like the British East India Company+ (founded in 1600) and the Dutch East India Company+ (founded in 1602, often described as the first multinational corporation+ in which stock was offered) were established.
The invention of shipping containers+ in 1956 helped advance the globalization of commerce. It became known as the global financial crisis+ and is recognized as the catalyst for the worldwide Great Recession+.
Since its inception, the concept of globalization has inspired competing definitions and interpretations, with antecedents dating back to the great movements of trade and empire across Asia and the Indian Ocean from the 15th century onwards. Globalization in China+ Globalization in China discusses the history of globalization in China; including the economic, social, cultural influences that have been integrated into Chinese society.
If a state is not dependent on another, then there is no way for either state to be mutually affected by the other.
This is one of the driving forces behind global connections and trade; without either, globalization would not have emerged the way it did and states would still be dependent on their own production and resources to function. It is argued that archaic globalization did not function in a similar manner to modern globalization because states were not as interdependent on others as they are today.




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